How to write a nursing reflection paper

Writing a nursing reflection paper is a chance to connect theory with practice, analyze your clinical experiences, and demonstrate professional growth. Unlike a simple summary of events, a good reflection paper uses a structured model to critically examine your thoughts, feelings, and actions.

Here’s a step-by-step guide, from choosing an experience to polishing the final draft.

Step 1: Choose a Significant Clinical Experience

Pick an event that sparked a reaction: something that surprised you, challenged your assumptions, went well (or poorly), or created a moral or ethical dilemma. Examples:

• A patient interaction that required cultural sensitivity
• A medication error or near miss
• A difficult communication with a family member or doctor
• Your first time performing a procedure (e.g., inserting a Foley catheter)
• An ethical conflict (e.g., a DNR order not being followed)

Tip: The best reflections come from ordinary moments you see differently in hindsight, not just dramatic emergencies.

Step 2: Select a Reflective Framework

Most nursing schools require a specific model. The most common is Gibbs’ Reflective Cycle (1988) because it’s clear and comprehensive. Others include Johns’ Model (more structured for nursing) or Driscoll’s “What?” model (simpler).

We’ll use Gibbs’ Cycle – it has six phases:

1. Description
2. Feelings
3. Evaluation
4. Analysis
5. Conclusion
6. Action Plan

Step 3: Structure Your Paper

Use standard academic formatting (1-inch margins, 12-pt font, double-spaced). Most nursing reflection papers are 750–1500 words. Include:

• Title page (if required)
• Introduction (1 paragraph)
• Body – one section per Gibbs phase (5–7 paragraphs)
• Conclusion (1 paragraph)
• Reference list (if you cite literature)

Step 4: Write Each Section Using Gibbs’ Cycle

1. Description (10-15% of paper)

Answer: What happened? Be factual, concise, and protect patient privacy (use initials or pseudonyms).

Example: “During morning medications on a medical-surgical unit, I entered Mrs. J’s room to administer metoprolol. She refused, stating ‘those pills make me dizzy.’ I explained the cardiologist’s order, but she remained adamant. I left the room without giving the medication.”

2. Feelings (10-15%)

Answer: What were you thinking and feeling before, during, and after? Be honest – anxiety, confidence, frustration, guilt.

Example: “Initially I felt frustrated, believing Mrs. J was being non-compliant. After leaving, I felt uneasy – had I missed something? Later I felt ashamed for judging her.”

3. Evaluation (15-20%)

Answer: What went well? What went badly? Distinguish facts from judgments.

Example: “It went well that I respected her refusal without arguing. What went badly was my failure to assess further – I didn’t ask ‘what does dizziness feel like?’ or check her blood pressure. I also didn’t document the refusal properly.”

4. Analysis (25-30% – most important section)

Answer: Make sense of the situation. Connect to nursing theory, pharmacology, ethics, or communication models.

• Pull in literature: Cite your textbook, journal articles, or hospital policy.
• Consider alternatives: What should you have done?
• Examine underlying issues: power imbalance, therapeutic communication (e.g., use of open-ended questions), medication side effects (e.g., metoprolol can cause hypotension → dizziness).

Example: “According to the NMC Code (2018), respecting patient refusal is essential, but so is exploring reasons. Metoprolol’s common adverse effect is orthostatic hypotension (Adams et al., 2020) – Mrs. J’s dizziness was likely real, not defiance. Using therapeutic communication techniques like ‘tell me more about the dizziness’ would have demonstrated empathy and gathered critical assessment data.”

5. Conclusion (10%)

Answer: What else could you have done? What have you learned?

• Two parts:
  • What you learned about the clinical issue
  • What you learned about yourself as a nurse

Example: “I learned that medication refusal is often a clue, not a barrier. I also learned my default is frustration rather than curiosity. I could have taken her blood pressure and notified the provider about a possible need for a dose adjustment.”

6. Action Plan (10-15%)

Answer: If the situation arose again, what would you do differently? Be specific and realistic.

• Include concrete behaviors, not just “I’ll do better.”
• Identify how you will gain needed knowledge or skills.

Example: “Next time a patient refuses medication, I will: 1) Ask two open-ended questions (‘what happens when you take it?’ and ‘what are you worried about?’); 2) Check vital signs before leaving; 3) Document refusal using the ‘R.E.A.D.’ format (Reason, Explanation, Alternatives, Decision). To improve, I will practice SBAR handoffs during my next clinical simulation.”

Step 5: Write the Introduction & Conclusion

Introduction: Briefly state the experience (without revealing outcome) and the model you’ll use. End with a thesis – what you ultimately learned.

Example: “This paper reflects on a medication refusal during my second clinical rotation. Using Gibbs’ Reflective Cycle, I analyze my initial frustration, the missing assessment steps, and how I will now approach patient autonomy with clinical curiosity.”

Conclusion: Summarize key insights and the change you’ll make. Do not introduce new information. End with a forward-looking statement about your nursing development.

Step 6: Protect Patient Confidentiality

• Never use real names, MRNs, dates of birth, or facility names.
• Use “Mr. S.” or “the patient.”
• Change non-essential details (e.g., “a Tuesday morning” not “May 12”).
• State in your paper: ”All identifying information has been anonymized.”

Step 7: Revise Using a Nursing Lens

Ask yourself:

• Did I move beyond storytelling to critical analysis?
• Did I cite at least 2-3 scholarly sources (nursing journals, textbooks, professional guidelines)?
• Did I show emotional intelligence (awareness of my biases and feelings)?
• Does my action plan show specific, evidence-based changes?

Example Outline (Gibbs Model)

Title: Reflecting on a Missed Assessment During Medication Refusal

Introduction (75 words)
Brief context + thesis.

Description (150 words)
What, where, who (anonymized), sequence of events.

Feelings (100 words)
Frustration → unease → shame.

Evaluation (150 words)
Good: respected refusal. Bad: no assessment, poor documentation.

Analysis (250 words)
Metoprolol pharmacology, therapeutic communication models (Heron’s Six Categories), NMC Code, power dynamics in nurse-patient relationship.

Conclusion (100 words)
Learned: refusal is clinical data. Learned about self: tendency to label patients.

Action Plan (150 words)
Three specific steps + reading one article on medication adherence.

References
Gibbs, G. (1988). Learning by Doing.
Adams, M. et al. (2020). Pharmacology for Nurses.

Common Mistakes to Avoid

Mistake	Better Approach
Just retelling the story	Analyze why things happened
“I felt bad” without explanation	“I felt anxious because I hadn’t yet developed assertive communication skills”
No literature or theory	Cite at least two sources (e.g., communication model, nursing ethics)
Vague action plan (“I’ll listen more”)	Specific action (“I will use the ‘Ask-Tell-Ask’ technique”)
Blaming others or systems	Focus on your own role and influence

Final Checklist Before Submitting

• Used a reflective model consistently
• Included feelings and critical analysis, not just description
• Cited evidence (textbook, journal, policy)
• Protected patient privacy
• Action plan is concrete and achievable
• Proofread for typos and passive voice
• Followed your instructor’s rubric (length, citations, formatting)

Writing a strong nursing reflection paper takes practice. The goal is not to write a confession or a heroic story, but to demonstrate that you can learn systematically from experience – the heart of reflective practice in nursing.